Depression, stigma and suicide

Mental illness is the most important underlying cause for many suicides. Approximately 15% of depressed patients ultimately kill themselves. For schizophrenia the risk is lesser, but still significant. Majority of such cases of depression go undetected. There is evidence to show that teaching general practitioners how to identify and treat depression is a very effective strategy to reduce suicide rate. Majority of these depressed persons self medicate themselves with alcohol or drugs. Many flock to alternative treatments. Some fail to gain emotional insight into their problem and adhere to treatment.
I remember a female who was my neighbor earlier for some time. She was a graduate, employed lady who used to visit many physicians; mostly she consulted gastro enterologists with complaints of 'gas, indigestion, occasional loose stools etc'. Several investigations were done, but drew a blank. Her diagnosis was 'Irritable bowel syndrome'. She used to come to me and discuss about her medical problems as a neighbor. On evaluation I found that she had most symptoms of depression, but was not wiling for treatment. She used to insist that she had no depression, but only some anxiety. Later i could persuade her to take some medication and also consult a psychologist. After some time I lost track of her; later she told me she is seeing another psychiatrist. I asked her to continue that. Then again she disappeared. Again I met her incidentally and with persuasion she continued drugs given by the other psychiatrist. I taught her some relaxation methods as well. After a few months when her husband and only child were away, she closed all doors and windows and consumed poison.
Somehow all her physicians, psychologist and the two psychiatrists (including me) failed to convince her about the need for treatment. She had a habit of arguing about the diagnosis. As my consultations were of a casual nature, she was free with me in expressing her disagreement about what mental health professionals thought about her problems.
What prevented her from accepting her diagnosis was the stigma associated with mental illness. Ultimately her husband lost her; her child lost its mother.
Stigma of mental illness is real. It causes undetected suffering. We cannot wish away mental illnesses. The only way out is proper recognition of the problem and treatment. If people prefer to consult non psychiatrist doctors, we have to train them suitably.